Secondary carcinomatas in case of carcinomatas of the oral cavity, of the pharynx and of the larynx. Clinical, histopathological and cellular kineticfindings

Background: The mortality because of malicious tumours of the oral cavity, of the pharynx and of the larynx has considerably increased in the Federal Republic of Germany during the last two decades. The prognosis not only sho ws a high ratio of recidivations and formation of metastases, but also a ty pical field canceration. There is a high rate of incidence of multiple prim ary, resp. secondary tumours that may occur synchronously or metachronously . Up to now we have learnt only little about the mechanisms concerning the development of rumours and their spread on the cellular molecular level. Me thod: The subject of the present retrospective study was the analysis of pa tients suffering from an epithelioma of the oral cavity, the pharynx and th e larynx and the following secondary carcinomatas. The control group were p atients suffering from primary tumours of the same location and subsequent recidivation or metachronous metastasis. By determination of the degree of malignity and keratinisation of the DNA ploidy, of the immunohistological e xpression of p53 and the immunohistological proliferation marker MIB1 concl usions had to he drawn with regard to the biological behaviour of tumours. Results: The evaluation of the clinical parameters of the 122 patients on t he whole revealed a clear increase of new disease as well as a shifting to the younger age within the last five years. Surprisingly, most common were secondary rumours in case of larynx carcinomatas. Patients suffering from s econdary tumours show a bad prognosis, however, their maximum survival does not differ considerably from that of patients suffering from recidivations , resp. metastases. Because of the early diagnosis of the secondary carcino matas the prognosis will depend on the primary carcinoma in most of the cas es. The prognosis data indicate that independently from the fact whether th ere is a primary or a subsequent tumour, the therapy to be applied can only be a combined therapy consisting of operation and ray-therapy. The present examinations confirm reports with regard to disturbance of the p53 regulat ion that also play an important role in case of the head-neck area. The par allel analysis of MIB1 as a proliferation marker showed in case of the prim ary carcinomatas a correlation of positive p53-immunocolour with moderate a nd strong proliferation. Tumours in the hypopharynx and larynx showed a sig nificantly smaller proliferation than that of the oral cavity and oropharyn x. in case of the primary and secondary tumours the proliferation is more c ommon in case of the G(3)-tumours. Conclusions: The in total modest differe nces between the primary and secondary carcinoma with regard to the DNA-plo idy; the proliferation and the p53-expression presumably originate in their formation within the scope of a so-called field canceration. Because of th e field canceration supposed for the mucous membranes of the upper aerodige stive tract, the check-ups of these patients performed in regular intervals must not be limited in any case to the area of the primary tumour. They wi ll have to consider the entire visible area of the upper respiratory and es ophageal tract.